Administration and Policy in Mental Health and Mental Health Services Research最新文献

Trauma exposure is prevalent among youth and associated with adverse outcomes. While evidence-based treatments (EBTs) for trauma-exposed youth exist, widespread dissemination into community practice is challenged by clinicians’ abilities to engage in EBT training. These challenges stem from many individual, agency, and neighborhood-level factors. This study utilized data from 231 therapists who participated in a statewide Learning Collaborative (LC) on TF-CBT to explore how individual, agency, and neighborhood-level factors may influence their level of participation in the training requirements. Preliminary results indicated that agencies in resource-deprived neighborhoods were associated with having therapists with more PTSD experience, but also reduced interagency collaboration and less use of agency-level trauma-informed practices. In contrast, therapists in neighborhoods with higher violent crime rates were reported to have less experience with trauma-exposed youth, yet their agencies had fewer reported community barriers, increased interagency collaboration, and more agency-level trauma-informed care. Finally, agency-level correlates of LC training participation suggest that agencies face a delicate balance in managing different aspects of evidence-based practices (EBPs) care and EBTs. Findings emphasize considering contextual factors when disseminating EBTs, as ensuring an optimal environment for training participation ultimately addresses growing mental health disparities for trauma-exposed youth.

Access to outpatient psychiatric care is often delayed, with many patients unable to obtain timely specialty evaluation. Integrated care models such as Collaborative Care Management (CoCM) and co-located care improve outcomes but have not been widely adopted due to resource and structural barriers. Direct outpatient psychiatric consultation may offer a feasible alternative, yet its effectiveness remains understudied.

We conducted a retrospective review of the Psychiatry Consultation Clinic (PCC) at a large academic medical center. The PCC provides diagnostic clarification and treatment recommendations to primary care providers (PCPs) rather than longitudinal psychiatric care. Adult patients (≥18 years) referred between October 2019 and October 2022 from family and internal medicine practices were included (N = 545). Primary outcomes were: (1) time to implementation of consult recommendations; (2) rate of psychotropic medication implementation; and (3) changes in anxiety (Gretrospective review of the Psychiatry Consultation AD-7) and depression (PHQ-9) scores. Secondary outcomes included psychiatric diagnoses and subsequent referrals for specialty care.

The median time from referral to consultation was 5 weeks, substantially shorter than the average 6-month wait for traditional psychiatry appointments within the same system. Most patients (88.1%) were seen once, and 83.1% of visits were conducted via telemedicine. Pharmacotherapy was recommended for 81.8% of patients, and 81.4% had at least one recommendation implemented, typically within 1–3 weeks. Antidepressants accounted for two-thirds of recommendations. For patients with pre- and post-consultation data, mean GAD-7 and PHQ-9 scores decreased significantly (−2.9 and −5.0 points, respectively; both p < 0.0001), with clinically meaningful improvements observed in depression symptoms. Nearly one-quarter of patients were referred for longitudinal specialty psychiatric care, with 70% establishing follow-up within six months.

The direct consultation model was feasible, resulted in high uptake of recommendations by PCPs, and was associated with improvements in patient symptoms, particularly depression. Compared with integrated models, this approach may be easier to implement in primary care settings with limited behavioral health infrastructure. Prospective controlled studies are warranted to establish the efficacy of this outpatient consultation model and compare it to other paradigms within the continuum of psychiatric care.

The global demand for mental health services has surged in recent years, yet the supply of trained specialists remains insufficient to meet population needs. This imbalance has prompted an urgent call to reconsider who can deliver effective mental health interventions. This special issue, Leveraging Nontraditional Mental Health Providers to Address Growing Mental Health Needs, brings together 17 contributions that examine the feasibility, acceptability, and effectiveness of nontraditional providers—peers, teachers, primary care providers, nurses, community health workers, and other lay providers—in diverse settings and populations. Collectively, these studies highlight how nontraditional providers can deliver both treatment and prevention interventions across schools, healthcare systems, community organizations, and virtual platforms. The findings demonstrate the promise of expanding the mental health workforce beyond traditionally credentialed specialists, while also identifying critical factors related to training, supervision, cost-effectiveness, and implementation. Importantly, the contributions illustrate that these providers are already filling essential gaps in access, particularly for children, underserved communities, older adults, and other priority populations. Taken together, the special issue underscores that the central challenge is no longer whether nontraditional providers can effectively deliver mental health interventions, but how to scale, sustain, and integrate these models into broader systems of care.

A quarter of US adults face mental health challenges, yet less than half receive treatment, partly due to therapist shortages. Scaling trained paraprofessionals to provide effective care could address this gap. We evaluated the impact of evidence-based coaching within a real-world blended care digital mental health platform. 266 working adults (62% women, M_age=33 years, 40% people of color) newly enrolled (2021–2022) in the platform (Modern Health) completed surveys at baseline and 3-months. Participants primarily engaged with certified professional coaches and could also access therapy and digital resources. We examined pre-post changes in outcomes and differences by baseline clinical status. Participants used an average of 2.5 coaching sessions and improved in distress tolerance (+ 4.1%), perceived stress (-8.4%), self-compassion (+ 5.9%), and mindfulness (+ 2.6%) (ps < 0.01). Although elevated risk users (vs. lower risk) reported descriptively greater improvements in distress tolerance (+ 4.7% vs. +3.7%), perceived stress (-10% vs. -3.7%), self-compassion (+ 7.6% vs. +5.2%), and mindfulness (+ 3.3% vs. +2.1%), these differences were not statistically significant (ps > 0.05). Depression (-22.5%) and anxiety (-12%) improved (ps < 0.001), with elevated risk users reporting greater reductions (b=-3.15, p < .001 for depression; b=-2.61, p < .001 for anxiety). Among elevated risk users, 71.7% improved or recovered from depression or anxiety and 96.1% of lower risk users maintained lower depression and anxiety. Technology-enabled coaching, as part of a blended care platform, improved depression, anxiety, and transdiagnostic emotional processes. Participants with higher baseline depression and anxiety reported greater improvements, highlighting coaching’s effectiveness for people with elevated needs. By redefining care and leveraging technology, coaching may be a scalable treatment solution.

People with serious mental illnesses continue to be overrepresented within the criminal legal system despite multiple diversion and reentry intervention efforts. Engaging in a coordinated systems-level approach to this problem has increased, as mental health criminal legal cross-systems collaborations, like Stepping Up and Sequential Intercept Mapping, proliferate across the United States. Despite their proliferation, little is known about how these cross-systems collaborations operate, including what factors are present and how these factors help or hinder group effectiveness. Stakeholders engaged in mental health criminal legal cross systems collaboration participated in focus groups and in-depth interviews. Using the Exploration, Preparation, Implementation, and Sustainment framework to guide the analysis, findings showed that inner, outer, and bridging factors feature predominately in cross-systems collaborations. Inner and outer contextual factors like leadership, values, funding, and data accessibility are important to their operations. Additionally, bridging factors of purveyors (engaging in technical assistance) and systems-level collaboration strategies (cross-training, sequential intercept mapping, and data sharing) were important to supporting sustainability. Future research should investigate which systems-level collaboration factors are tied to the implementation of new practices, programs, and policies which in turn may improve the behavioral healthcare system and health outcomes for people with serious mental illnesses.

This study aimed to identify predictors of homelessness among transitioning service members (TSM) in the military. Data from the U.S. Departments of Defense (DoD) and Veterans Affairs (VA) were analyzed. A total of 211,530 TSM discharged from military service between August 2022 to December 2023. Military and clinical characteristics of TSM were examined along with any indicator of homelessness in VA records within 1 and 2 years after military discharge. Multivariable logistic regression and survival analyses were conducted. Results found that the incidence of homelessness among TSM was 1.85% within 1 year of military discharge and 2.95% within 2 years of military discharge. Among the strongest predictors of homelessness, TSM who were non-Hispanic black (aOR = 3.16, 95% CI = 2.92–3.41) or who had reasons for military discharge related to hardship (aOR = 3.26, 95% CI = 2.54–4.118), mental health/substance use (aOR = 3.89, 95% CI = 3.42–4.41), or criminal activity (aOR = 4.24, 95% CI = 3.76–4.78) were at risk of homelessness within 1 year of military discharge. Similar predictors were found among TSM for homelessness in year 2 suggesting the risk factors remain the same over time. In conclusion, some of the risks for homelessness may be ascertained from TSM while they are still in the military. Special support for TSM who are discharged due to hardship, mental health/substance use problems, and criminal activity may help prevent homelessness among veterans.

In mental health care, shared decision making (SDM) is a central part of the recovery paradigm. However, implementing SDM can be challenging, and professionals may prefer different decision-making styles. This study explored preferences for decision-making style and examined their association with knowledge of and attitudes to recovery among mental health professionals in routine hospital-based services. An exploratory cross-sectional survey was conducted among mental health professionals (N = 552) in hospital-based services in one of Denmark’s five regions. Preferences for decision-making style were measured using the Clinical Decision Making Style Scale – Staff Questionnaire, while professionals’ knowledge of and attitudes to recovery were assessed using the Recovery Knowledge Inventory. Although the majority of participants (72.4%) preferred a shared decision-making style, there were differences in preferences based on profession, work experience, and setting. One in five reported having received SDM training, and fewer reported having access to decision-support tools. Indications of differences in knowledge of and attitudes to recovery between professionals’ preferences for decision-making styles were found: those who preferred a shared or active style seemed to score higher on the RKI compared to those who preferred a passive, clinician-led style. While descriptive in nature, the findings suggest patterns in decision-making preferences that may help inform future implementation efforts. The results also suggest a potential alignment between endorsement of shared- or active decision-making styles and recovery-oriented values. Further research is needed to investigate how preferences translate into actual clinical practice and how knowledge about and attitudes to recovery may be operationalized as recovery-oriented care.

Parental substance use represents a significant source of family separation in the U.S. child welfare system. Family-focused substance use treatment programs are an innovative approach to keeping families safely together while addressing the impacts of parental substance use on children and the family system. Yet, we know very little about how families experience this new type of treatment, particularly as it relates to trauma-informed care (TIC). This qualitative study examines the experience of 24 parents participating in the In-Home Recovery Program (IHRP), an intervention that provides substance use and early child relational health treatment to families at risk of separation in the child welfare system. A content analysis indicated that IHRP was highly valued by families. The majority of participants experienced the intervention as uniquely helpful and supportive compared to other forms of substance use treatment they had previously received. Results suggest that IHRP is a model that operationalizes principles of TIC and which could be expanded as a supportive approach to parental substance use in the child welfare system to prevent family separation.

Surging rates in child internalizing problems require teachers to serve as frontline responders, especially in marginalized urban communities where structural barriers constrain access to healthcare resources. The current mixed methods study examined teachers’ use and perceptions of tools for addressing anxiety in urban elementary schools serving predominately low-income and Black and Hispanic youth. Across surveys (N = 82) and interviews (n = 12), teachers were asked about their current practices, their perceptions of the most common evidence-based practice elements for youth anxiety, and their preferences for professional development (PD) materials going forward. All teachers endorsed use of evidence-based practices for anxiety. Among the practices assessed, teachers were most enthusiastic about using modeling, praise/rewards, cognitive coping, and relaxation strategies, and were least enthusiastic about exposure, self-monitoring, and psychoeducation. In interviews, teachers noted key facilitators (e.g., keeping strategies time-limited), and highlighted other “setting up for success” strategies (e.g., building relationships with students) that work to minimize anxiety in classrooms. Teachers with higher self-efficacy and sense of personal accomplishment perceived evidence-based practices for student anxiety as more usable, underscoring the importance of teachers’ job-related wellness in student mental health promotion. Teachers preferred PD materials that were time-limited, asynchronous, and engaging. Taken together, findings indicate that many teachers are already incorporating evidence-based anxiety practices into their routines. Results inform policy and practice recommendations, and suggest value in leveraging teachers’ existing practices and opinions to develop relevant PD materials that optimize practices for addressing child anxiety in urban schools.

Schools are a key setting where services to support youth mental health can occur, and teachers are important for students’ social, emotional and behavioral well-being. Teacher-delivered mental health prevention and intervention programs offer an opportunity to integrate mental health support meaningfully into students’ everyday lives, as well as expand the reach and impact of mental health services. This is particularly important given the lack of highly trained mental health providers and the barriers to accessing clinical services. However, teachers are not trained as mental health providers and serve a primarily educational mission, and therefore, there are unique considerations for conceptualizing teachers as individuals who can deliver mental health prevention and intervention programs. The purpose of this paper is to delineate conceptual and practical issues related to utilizing teachers as non-traditional mental health providers including key opportunities and challenges to teacher-delivered mental health interventions. We present four examples of teacher-delivered programs that aim to support student mental health and well-being and use these example programs to illustrate these key opportunities and challenges. We also outline directions for future research, with the ultimate goal of enhancing teachers’ skills and improving youth mental health.